肝硬化门脉高压胃底静脉曲张防治新进展

New progress in preventing and controlling gastric varices in liver cirrhosis patients with portal hypertension

食管胃底静脉曲张破裂出血(EGVB)是肝硬化严重并发症之一,其病死率高、再出血风险大。而胃底静脉曲张较食管静脉曲张发生率低,但一旦发生,出血严重程度大于食管静脉曲张,且易反复出血。目前国内外推荐的用于胃底静脉曲张的常用治疗方法包括:药物治疗、内镜下治疗、介入治疗及外科手术治疗。其中药物治疗用于胃底静脉曲张的一级预防,而内镜下组织胶注射为最常用的治疗胃底静脉曲张的方法,针对胃底静脉曲张急性出血主要应用内镜治疗及介入治疗,如经颈静脉肝内门体分流术(TIPS),而球囊导管逆行性静脉栓塞术(BRTO)主要用于伴有胃肾分流及脾肾分流的患者。近年来,随着内镜治疗及介入治疗技术不断创新,胃底静脉曲张在治疗方面也有了很大发展,与单一方法治疗胃底静脉曲张相比,内镜联合介入治疗在控制胃底静脉曲张复发及再出血方面已有了更加前沿的研究,本文就目前有关胃底静脉曲张治疗现状及研究进展做一综述。

Esophageal and gastric varices bleeding（ EGVB） is one of the most significant complications of liver cirrhosis,which can lead to a high rate of mortality,as well as the risk of rebleeding.Compared with esophageal variceal bleeding,incidence of gastric variceal bleeding is lower but is more severe,and could often result in repeated bleedings. The common treatments include drugs,endoscopic therapy,radiologic therapy,and surgical operation. Drugs often a method of primary prophylaxis,while endoscopic glue injection is the most common way to relieve gastric varicosity. As for acute gastric varicosity bleeding,endoscopic therapy as well as radiologic method,for instance transjugular intrahepatic portosystemic shunt（ TIPS） and balloon-dccluded retrograde transvenons obliteration（ BRTO）,are better ways that could control situation,and BRTO as an efficient strategy is suitable for the patients who have spleen renal shut and gastro renal shut. In recent years,with the renewal and replacement of endoscopy and radiology,therapies aiming at gastric varicosity have also changed a lot,and comparied with a single metod,there has been prospecting research on combining endoscopy with radiology to decrease recurrence and re bleeding. In this review,new treatment modalities in the form of drugs and endoscopic treatment as well as radiological procedures are discussed.